covenant presentation Getting the Framework Right
Transcript of covenant presentation Getting the Framework Right
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CME Disclosure
Accreditation StatementStuder Group is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Designation of CreditStuder Group designates this educational event for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the educational event.
Disclosure PolicyJan McNally and Janice McKinley have disclosed that they do not have any relevant financial relationships with any commercial interests related to the content of this educational event.
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Getting the Framework
RightHow Evidence-Based
Leadership Empowers 11,000 Professionals to
Improve in Unison
Presented By:Janice McKinley, RN, FACHE, NEA-BCSVP Quality & Nursing Jan McNally, BS, BSN, MSHSA, FACHECorporate Director - LeadershipCovenant Health – Knoxville, Tennessee
Journey to Excellence
A Journey, Not a Destination…
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Objectives
Describe a Framework for Driving System-wide Performance
Discuss Lessons Learned
Share Tips and Takeaways for Other Organizations
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We serve the community by improving the quality of life
through better health.
Mission
Covenant Health – First ChoiceCovenant Health’s clinical and service
excellence will make us the first and best choice for patients, employees, physicians, employers, volunteers and the community.
Vision
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Journey Begins With…
Board of Directors and CEO:
– Board-Appointed Quality Committee
– Commitment to Quality Pledge 2002
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Executive Leadership
Executive Leadership’s Commitment Drives:Patient Safety
Quality
Engaged Employees, Physicians, and Leaders
Partnership With Studer Group
Board and ELT’s Commitment to Seek Best Practices to Improve Patient Safety, Quality and Service
– Evidence Based Leadership
– Focused Coaching Plans
– Deployment
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Timeline
2006 - Limited Partnership at Parkwest Medical Center
2007 - Expanded to Encompass All of Covenant Health System
2008 - Adoption of the LEM for Performance Management for all Covenant Leaders2009 / 2010 - Hardwired the “Must Haves”2011 – Focus on System Alignment2012 – Continue and Expand Focus on System Alignment
Timeline
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Engaged Competent Leaders
Quarterly System-Wide and Facility LDIs– CEO Scorecard Reports and Market Updates
– Executive Leadership Reports on System Quality, Patient Safety / Value Based Purchasing, Employee Engagement
– Quarterly Facility Employee Forums - Connect the Dots for All Employees
Good Intentions to Results
Common, Aligned Goals
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Goal Selection Process
Executive Leaders and Board of Directors Identify Goals for Upcoming Year
Pillar Framework for Balanced Approach and Focus
Executive Leadership Team (ELT) Communicates to Senior Leaders Across Health System
Do Your Goals Drive Performance?
Lessons Learned:– How to Use the LEM Team Effectively
– How to Use Effective, Equitable Weighting
– How to Drive a System Approach Using Goals and Weighting
– How to Cascade to the Right Leaders, i.e. Who Carries the Goal?
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Provide Expertise and Recommendations to ELT– National and Regional Benchmarks for
Goal Targets
– Statistical Analysis of Current Data
– Facility Best Practices
– Coaching Leaders in Goal Development
System LEM and Measurement Teams
Weighting
Use to Drive Focus for Leaders
Tailor to Department, Unit, Service Based Upon Current Performance and Role in Contributing to Organization’s Goals
Incentivize System Alignment and Teamwork, Sharing Best Practices
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Health System or System of Sovereign States?
Executive Direction
Common Goals
Lesson Learned: A Good Start
Best Practice
Goal Weighting to Share in a System Goal:
– 30% of Goal Target is Achieved by the Health System Meeting Its Goal for Patient Safety
– 20% of Goal Target is Achieved by System Finance Goal Being Met
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Goal Cascading Process
Senior Leaders (System Vice-Presidents, CAOs) Communicate Goals to Entity-Level Leaders (VPs)
VPs Review with Managers and Directors and Propose Targets
Lesson Learned: Critical Step!
Senior Teams at Entity Review and Approve Goals and Targets for All Leaders to Insure Equity, Alignment and Entity-Level Success
Executive Leaders Review and Approve Senior Team Goals, Targets and Weighting
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Covenant Health VisionFirst and Best Choice for Employees to Work– System Goal: Reduce or Maintain
Turnover to X% to Insure Stable Workforce• Entity Turnover Goal (ex. Hospital, IT Division)
• Departmental Turnover Goal (ex. ICU, ED)?
–When Does It Make Sense? What Weight?
Quality Commitment
First and Best Place for Patients to Receive Care
– Goal: Reduce Patient Safety Events by X%
Covenant Health Vision
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Operationalizing the Journey
Aligned Goals / LEM
Comprehensive Scorecards
System Transparency
Accountability
Organizational Structure
President &CEO
ExecutiveVice President /
HospitalOperations
SeniorVice President
Quality, Safety & Nursing
Operations
Directors / Clinical
Effectiveness
NursingOperations /
Facility CNOs
Facility CAOs
ExecutiveVice President /
HumanResources
Corporate Director /
LeadershipDevelopment
Vice PresidentLearning & Leadership
Development
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Transparency & Accountability
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2012
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A System Approach: Patient Safety BundlesSystem-Wide Deployment of Evidence Based
Bundles:– Hand Hygiene– Central Line Insertion / Maintenance– VAP Prevention– MRSA / MDRO Prevention– Decubitus Prevention– VTE Prevention– Catheter Related UTI Prevention– Falls Prevention– C-difficile
Patient Safety Events: Chasing Zero2010
System Goal of 25% in All Harm EventsHospital Specific Goals– CNO Scorecard Developed
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Patient Safety Events: Chasing Zero2010
System Goal of 25% in All Harm EventsHospital Specific Goals
2011System Goal of Additional Reduction of 20%– Patient Safety Scorecard– Shared Incentive with Senior Team
70% Hospital / 30% System
Patient Safety Events: Chasing Zero2010
System Goal of 25% in All Harm EventsHospital Specific Goals
2011System Goal of Additional Reduction of 20%
2012System Goal of Additional Reduction of 10%
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Patient Safety
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Ventilator Associated Pneumonia
9358 9647 9232 9058 9220
11336 1086011801
55
30 39
18 20 105
02000
40006000
800010000
1200014000
2004 2005 2006 2007 2008 2009 2010 2011
# Ve
nt D
ays
051015202530354045
# VA
Ps
Vent Days # Cases
Untangling the Economics of QualityMean Cost per Incident
Sources: Beaver, Michelle, “CMS to Put Pressure on Providers for Decubitus Ulcer Prevention”, Infection Control Today, August 2008
Scott, R. Douglas, “The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention,” March 2009.
Spetz, Joanne, PhD, “Cost Effectiveness of a Medical Vigilance System to Reduce Patient Falls, Nursing Economics, January 2008
$43,180
$18,222
$24,070 $26,000
$934
$4,233
$23,272
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
Pressure Ulcer BloodstreamInfection
VentilatorAssociatedPneumonia
MRSA Urinary TractInfection
Patient Fall Surgical SiteInfection
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Business Case for Quality Efforts
Pressure Ulcers: Stage III, IV & Unstageables
Patient Falls: F - I
Total Estimated Cost Avoidance = $3,887,182
Total Estimated Cost in 2009 = $9,775,351Total Estimated Cost in 2010 = $7,031,165Total Estimated Cost in 2011 = $7,938,455
System Goal for Core Measures
Examples of Goals at Each Level:– System
• 98% Composite• 75% at 100%
– Hospital– Service Line: ED– Unit or Work Area: Nursing Unit
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Core Measure Compliance
91.5%
95.2%
98.7%98.0%97.4%
90%
95%
100%
2007 2008 2009 2010 2011
MHHS Core Measure Compliance
99.9%
89.7%
85%
90%
95%
100%
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4th Q
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HCAHPS Goal Example
SystemAchieve Threshold on all Measures
HospitalsShared by Senior TeamDirectors and Managers
HCAHPS – Overall Hospital
73.4%72.9%71.8%71.1%70.0%72.7%
50%
60%
70%
80%
90%
100%
2006 2007 2008 2009 2010 2011
Overall Rating Benchmark Threshold
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Value Based Purchasing
Developed IndexDeployed Monthly Analysis on All Elements of VBP
Action Plans Developed & Communicated to ELT
Working with VHA to Predict Payment Model
System Turnover Goal
Hospital Turnover Goal– Unit Specific Turnover Goal
– Describe How Weighting is Used to Focus Areas With High Turnover, Lower Weighting For Areas to Maintain Current Turnover
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Voluntary TurnoverSystem Overall
11.37% 11.57%
10.86%
8.61% 9.24% 9.44%
6%
7%
8%
9%
10%
11%
12%
2006 2007 2008 2009 2010 2011
Vol Turnover Linear (Vol Turnover)
Voluntary Turnover - RNs System Overall
11.1%9.7%
10.4%10.5%11.8%11.5%
6%8%
10%12%14%16%18%20%22%
2006 2007 2008 2009 2010 2011
Vol Turnover National Avg
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Ongoing Journey
The Journey Continues
Performance Excellence Awards
External Recognition
Buscetta Leadership Award
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Annual Performance Excellence Awards Ceremony
Recent External Recognition2011 President’s Award of Honor– VHA, Inc.
VHA Leadership Award / Sustainability Excellence Award: Best in Class – Comprehensive Program– VHA, Inc. (Parkwest Medical Center)
VHA Leadership Award for Supply Chain Management Excellence– VHA, Inc.
VHA Leadership Award for Clinical Excellence– VHA, Inc. (Parkwest Medical Center)
VHA Leadership Award for Clinical Excellence– VHA, Inc. (Methodist Medical Center)
Reduction in MRSA – Silver Award– VHA, Inc. (Parkwest Medical Center)
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Recent External Recognition#1 Hospital in Knoxville Metro Area – US News & World Report (Methodist Medical Center)
Best Performing Health Systems in US– Thomson Reuters
Top 100 Integrated Health Networks– SDI
Pinnacle Business Award – Impact Award for Improving Quality of Life in East Tennessee– Knoxville Chamber of Commerce
2011 Top 100 Hospital Designation– Thomson Reuters (LeConte Medical Center)
Covenant Health Market ShareInpatient Discharges:16-County Service Area
41.2%40.8%
35.5%
34.1%
31.3%31.2%
31.0%
30.3%
30.9%31.3%31.5%
32.8%33.6% 34.5%
35.4%
34.0%
32.4%
29.0%
31.0%
33.0%
35.0%
37.0%
39.0%
41.0%
43.0%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Jan-Sep2011
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Summary
Balanced ApproachExecutive and Board CommitmentEstablished Framework for DeploymentPositive Results for Each Pillar
Journey - Not a Destination
Objectives
Describe a Framework for Driving System-wide Performance
Discuss Lessons Learned
Share Tips and Takeaways for Other Organizations
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Contact Information
Jan McNally, BS, BSN, MSHSA, FACHE– [email protected]– (865)531-5274
Janice McKinley, RN, FACHE, NEA-BC– [email protected]– (865)531-5326
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You must take the entire survey to receive your CME Certificate.To take the survey, visit www.studergroup.com/webinar15To receive CME credit for this webinar you must take the survey prior to June 26, 2012. After June 29th you will receive an email with instructions on how to download your certificate.
The Studer Group is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Studer Group designates this educational activity for a maximum of 1AMA PRA Category 1CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity
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